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Salter-Harris Epiphyseal Fractures
- General Considerations
- The epiphyseal plate (physis or growth plate) is the weakest part of the bone to shearing injuries
- The Salter-Harris classification is a means of categorizing epiphyseal plate fractures and provides clues to their prognosis
- All such these fractures, by definition, involve or extend through the epiphyseal plate so that all such fractures occur in children before the epiphyseal plate closes
- Salter-Harris I Fractures
- Occurs through the hypertrophic zone of the epiphyseal plate
- Only the epiphyseal plate is fractured
- Rarely produces complications
- May be difficult to diagnose unless there is visible displacement of the epiphysis on the metaphysis
- Slipped capital femoral epiphysis (SCFE) is an example of a Salter-Harris I fracture
- Salter-Harris II Fractures
- Most common Salter-Harris fracture -85%
- Involves both the epiphyseal plate and the metaphysis
- Small corner of metaphysis that is usually fractured produces the “corner sign”
- Rarely produces complications
- Salter-Harris III Fractures
- Involves the epiphyseal plate and the epiphysis itself
- Since the epiphysis is involved, damage to the articular cartilage can occur
- Growth disturbance is uncommon
- A Tillaux fracture of the ankle is a Salter-Harris III fracture
- Salter-Harris IV Fractures
- Involves the epiphyseal plate, metaphysis and epiphysis
- Since it, too, involves the epiphysis, the articular cartilage can be damaged
- Since these fractures involve the growing layer of cartilage, growth disturbance can result
- Salter-Harris V Fractures
- Rare
- Compression or crushing injury of epiphyseal plate
- Initial diagnosis may be difficult and not made until complication of growth disturbance at epiphyseal plate occurs resulting in angular deformities
- Associated with growth disturbance
- These injuries have the worst prognosis of the Salter-Harris fractures
Structures involved in Salter-Harris fractures
|
Type |
Involves epiphyseal plate |
Fracture of metaphysis |
Fracture of epiphysis itself |
I |
Yes |
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II |
Yes |
Yes |
|
III |
Yes |
|
Yes |
IV |
Yes |
Yes |
Yes |
V |
Yes |
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- Clinical Findings
- Point tenderness
- Pain
- Swelling
- Limitation of motion
- Imaging Findings
- Soft tissue swelling
- Depending on the type of fracture, some displacement of the epiphysis or corner sign (Thurston-Holland fragment)
- Conventional radiography remains study of first choice
- CT with multiplanar reconstruction has been used in problem cases
- Ultrasound can be helpful in infants whose cartilage has not yet ossified
- MRI in problem cases
- Complications
- Complications are rare
- In general, the higher the number, the more likely the complication so that Salter-Harris types Iv and V have the highest associated complications
- Greater risk for complication comes with fracture of distal tibia followed by distal femur
- Primary complication is growth plate disturbance
- Early closure
- Closure of only a portion of the plate resulting in angular deformity
Salter 1 Fracture of the Proximal Humeral Epiphysis. Frontal radiograph of the shoulder in external rotation demonstrates slip of the proximal humeral epiphysis medially and inferiorly (black arrow) due to a fracture through the epiphyseal plate that causes widening of the plate (white arrow). The normal epiphyseal plate should not be confused for a fracture (see box).
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